Wound necrosis following dacryocystorhinostomy in patients with Wegener's granulomatosis

Two patients with Wegener's granulomatosis underwent dacryocystorhinostomy (DCR) for nasolacrimal duct obstruction and epiphora. Wound necrosis occurred in each individual with the formation of a nasal-cutaneous fistula. A pedicle flap was the treatment of choice in one case, while direct closure of the necrotic incision site and high-dose steroid therapy was used in the other. Both did well with complete wound healing. The tearing persisted in one and resolved in the other. Dacryocystorhinostomy should be avoided whenever possible in patients with Wegener's granulomatosis, and steroid dosage should be increased if surgery is necessary in the presence of active inflammation.